Too Much of a Good Thing : Symptoms and Treatment of Excess Cannabis Ingestion

Cannabis was recently approved by the voters in Nevada for recreational use, in addition to its previous approval by Nevada voters in 2000 for medical use. Inevitably, approval of recreational use of cannabis will lead to some individuals with little to no cannabis experience trying cannabis for the first time.

Recently, in other states where cannabis has been approved for recreational use, emergency room visits associated with cannabis have increased. In a letter to the New England Journal of Medicine, visits to Denver emergency rooms that were associated with cannabis use by out-of-state visitors nearly doubled the year after recreational cannabis was approved, primarily associated with ingestion of edibles and a lack of knowledge of their onset and effects. New cannabis users, as well as very occasional cannabis users, are unaware of just how much to take. They also are likely to try edibles first, as this route does not require any additional equipment (pipes, papers etc.) to consume the cannabis. They might start with a standard dose, but may not wait the recommended 30 minutes to an hour for the dose to take effect. This leads them to take more doses, resulting in uncomfortable effects such as poor coordination, decreased muscle strength, shaky hands, dizziness, drowsiness, decreased concentration, slowed reaction time, slurred speech, confusion, and short-term memory loss. A very small number of individuals can even experience delusions, hallucinations, anxiety, and agitation, mostly caused by elevated levels of one of the cannabinoids: delta-9 tetrahydrocannabinol (THC). Because of these undesired effects of too much THC, they seek treatment at the emergency room.

But, is an emergency room visit truly necessary for a cannabis overdose? Here is what you need to know:

1. Cannabis overdose is unlikely to result in death. Cannabis ingestion alone has not been linked to any overdose-associated deaths. In fact, published lethal doses are merely estimates of the lethal dose based on animal studies, since no known overdose deaths have been recorded.
2. Cannabis overdose is often treated with supportive care such as fluids, rest, and monitoring. In most cases, this can be done at home rather than the emergency room. Most of the effects, such as agitation, confusion, and anxiety, are uncomfortable, but not life-threatening, and will wear off as the THC leaves the system, usually within 6-12 hours for new or occasional users. Smoked cannabis wears off more quickly than cannabis incorporated into edible products. In rare individuals, the effects may take as long as 24 hours to fully resolve after ingesting edible products. However, in chronic users, as tolerance to cannabis builds, intoxicating effects will wear off sooner.
3. The reasons to go to the ER include: unexplained or new-onset chest pain, rapid heartbeat, or difficulty breathing; hallucinations/paranoid delusions, especially if they last more than 24 hours or are a safety risk to self or others; or new-onset symptoms of stroke such as weakness or numbness only on one side of the body, difficulty speaking, sudden and severe headache, or sudden trouble walking. Although rare, these could be severe reactions to THC and should be checked out. If heart attack, irregular heartbeat, acute psychosis or stroke occur after cannabis ingestion, cannabis should be avoided.

In conclusion, common adverse overdose reactions to cannabis include decreased coordination, decreased muscle strength, shaky hands, dizziness, drowsiness, impaired concentration, slowed reaction time, slurred speech, confusion, and short-term memory loss. These reactions will wear off as cannabis is metabolized and eliminated from the body, and do not require a visit to the emergency room. Treat with rest, fluids, and treat the symptoms as able. If any severe unexplained reactions, such as chest pain or difficulty breathing occur, seek medical attention at your nearest emergency room. Otherwise, just try to relax, ride out the symptoms, and remember to take a little less cannabis the next time.